Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, University Lille, Lille, France.
Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk, Belgium.
Ann Surg Oncol. 2022 May;29(5):2791-2801. doi: 10.1245/s10434-021-11110-x. Epub 2021 Nov 26.
Several randomized controlled trials (RCTs) have demonstrated improved short-term outcomes of totally minimally invasive esophagectomy (TMIE) compared with open esophagectomy (OE); however, to what extent these outcomes can be extrapolated to a national level remains debatable.
The aim of this study was to evaluate, on a nationwide basis, the short-term outcomes of TMIE and to analyze these results within the context of previously implemented hybrid minimally invasive esophagectomy (HMIE).
All consecutive patients who underwent a curative Ivor Lewis esophagectomy in France between 2017 and 2019 were included in this retrospective cohort study. The primary endpoint was to compare 90-day postoperative mortality (POM) between OE, HMIE, and TMIE, while secondary endpoints were defined as the rate of postoperative complications. A matched and multivariate analysis was adjusted for confounding factors.
Overall, 2675 patients were included (1003 OE vs. 1498 HMIE vs. 174 TMIE). In every center where TMIE was performed, HMIE had been previously adopted. The matched 90-day POM rate in the TMIE group was significantly lower compared with the OE group (2.3% vs. 6.3%, p = 0.046) but not compared with the HMIE group (2.3% vs. 4.9%, p = 0.156). There was no significant difference between TMIE and OE, or TMIE and HMIE, regarding the 30-day fistula rate (21.8% vs. 17%, p = 0.176; and 21.8% vs. 21.3%, p = 0.88, respectively). TMIE was associated with a reduced rate of pulmonary complications compared with OE (33.9% vs. 44%, p = 0.027) and HMIE (33.9% vs. 42.8%, p = 0.05). Low-volume centers were identified as a negative predictive factor for 90-day POM (odds ratio 1.89, 95% confidence interval 1.3-2.75, p = 0.001).
TMIE is associated with a lower 90-day POM rate compared with OE and offers reduced rates of pulmonary complications compared with OE and HMIE. After previous adoption of the HMIE technique, TMIE can be safely implemented in high-volume centers nationwide.
几项随机对照试验（RCTs）表明，完全微创食管切除术（TMIE）与开放食管切除术（OE）相比，短期结果得到改善；然而，这些结果在多大程度上可以推广到全国水平仍存在争议。
本研究旨在全国范围内评估 TMIE 的短期结果，并在先前实施的杂交微创食管切除术（HMIE）的背景下分析这些结果。
本回顾性队列研究纳入了 2017 年至 2019 年间在法国接受根治性 Ivor Lewis 食管切除术的所有连续患者。主要终点是比较 OE、HMIE 和 TMIE 的 90 天术后死亡率（POM），次要终点定义为术后并发症发生率。调整混杂因素后进行匹配和多变量分析。
共有 2675 名患者入选（1003 名 OE 与 1498 名 HMIE 与 174 名 TMIE）。在实施 TMIE 的每个中心，之前都已采用 HMIE。TMIE 组的 90 天 POM 率明显低于 OE 组（2.3%比 6.3%，p=0.046），但与 HMIE 组无差异（2.3%比 4.9%，p=0.156）。TMIE 与 OE 或 TMIE 与 HMIE 之间的 30 天瘘管率无显著差异（21.8%比 17%，p=0.176；21.8%比 21.3%，p=0.88）。TMIE 与 OE（33.9%比 44%，p=0.027）和 HMIE（33.9%比 42.8%，p=0.05）相比，肺部并发症发生率较低。低容量中心被确定为 90 天 POM 的负预测因素（优势比 1.89，95%置信区间 1.3-2.75，p=0.001）。
TMIE 与 OE 相比，90 天 POM 率较低，与 OE 和 HMIE 相比，肺部并发症发生率较低。在先前采用 HMIE 技术后，TMIE 可在全国高容量中心安全实施。
